Asking
for help.
One sentence, several readings. What is this person actually struggling with?
The same words from a client can point to very different problems. This case takes one ordinary sentence and shows what different therapy approaches would notice in it, what each might miss, and how the client’s own answer changes the picture.
What this is: a worked comparison of how several therapy approaches might hear one statement about needing help.
Why it matters: a therapist who decides too quickly what the sentence means can end up treating the wrong problem, for example questioning a “belief” when the real issue is a care service that treats the client badly.
The sharpest reframe: the sentence alone doesn’t tell you the problem. The next question does.
One thing to take away: ask what the hardest part is before choosing a theory.
The short version
“I hate needing help” might be about shame learned long ago, about a relationship changing, about a care service that is rushed or disrespectful, or about grief for a body that used to manage alone. Often it is several at once. Each therapy approach tends to hear one of these first. Good practice means asking which one matters most to this person now, and being ready to change course when the answer surprises you.
The case
Róisín is in her mid-forties and has multiple sclerosis. Over the past year her hands and balance have changed, and she now needs help getting dressed most mornings. On weekdays a personal assistant comes through an agency. At weekends her husband, Cathal, helps.
In her fourth therapy session she says, flatly: “I hate having to ask someone to help me get dressed.” Then she changes the subject.
She has started skipping breakfast so the morning goes faster, and she has stopped going to her Saturday book group. Róisín is an illustrative composite, not a real person.
What each approach would look for
Theory comparisonThese summaries describe what each approach characteristically attends to. They are simplified for comparison and are not complete accounts of any model. The “what it can miss” notes are this site’s disability-informed reading, not criticisms the approaches make of themselves.
Person-centred
Notices what Róisín feels she is allowed to feel and need. Carl Rogers described “conditions of worth”: learning that you are acceptable only when you meet certain conditions, such as coping alone.
“What is it like for you to need this?”
What it can miss: the possibility that the problem is mainly outside her, in how help is given.
Relational and object relations
Notices what happens between Róisín and the person helping her: closeness, power, gratitude, resentment, privacy, and what receiving care means in each relationship.
“What happens between you and the person helping, in those minutes?”
What it can miss: practical problems with the service, if every difficulty is read as relational meaning.
Attachment
Asks whether needing practical help is being experienced as a threat to security or to being loved, and separates that from actual insecurity.
“When you need help, what do you expect will happen?”
What it can miss: that practical dependence is not attachment insecurity. Needing help to dress says nothing, on its own, about attachment.
CBT
Notices the predictions and interpretations around asking: “I’m a burden”, “they’ll resent me”, and the behaviours they lead to, such as skipping breakfast to shorten the morning.
“What goes through your mind just before you ask?”
What it can miss: that some predictions are accurate. If the agency really does rush her, that is not a distortion.
ACT
Asks what matters to Róisín in her mornings and her week, what she can make room for, what she can change, and what deserves resistance.
“If mornings went the way you wanted, what would they protect?”
What it can miss: that “acceptance” can slide into accepting poor treatment. Acceptance of the body is not acceptance of a disrespectful service.
Narrative
Asks where the story “needing help makes me a burden” came from, who wrote it, and whether Róisín has other stories about herself that it crowds out.
“Where did you first learn that needing help says something about you?”
What it can miss: present-day conditions that keep the story alive.
Compassion-focused
Notices the tone of Róisín’s self-talk about needing help, and whose standards it echoes.
“How do you speak to yourself in those moments?”
What it can miss: anger that is justified. Soothing someone is not the same as agreeing that how they are treated is fine.
Systemic
Asks who carries the work of care, who decides how it is done, and how the agency, the marriage and wider family fit together.
“Who decides how your mornings are organised?”
What it can miss: her inner experience, if the focus stays on the system.
Disability studies and independent living
Asks whether the help is reliable, respectful and under Róisín’s control. In the independent living tradition, independence means choice and control over assistance, not doing everything yourself.
“Is the help organised around you, or are you organised around it?”
What it can miss: personal feelings that remain even when help is good.
Every approach is partly right here. None of them, alone, tells the therapist which reading fits Róisín.
How Róisín’s answer changes the picture
Our frameworkSuppose the therapist asks one simple question: “What’s the hardest part of it for you?” Here are four different answers Róisín might give. Each points to a different focus. The labels use this site’s Mine, Yours, Ours, System framework, where “Ours” means what happens in the relationship between people.
Answer A: the service
“It’s the agency. It’s a different person most mornings. They’re in a hurry. Last week one of them talked over me to Cathal as if I wasn’t there.”
Where the problem mostly sits: System, then Ours.
A helpful focus: taking the anger and humiliation seriously, and supporting Róisín to change the arrangement: a consistent assistant, more time, a complaint, or a review of her care package. Questioning whether she is “really” a burden would miss the point.
Approaches that fit best: disability-informed and systemic thinking, with CBT or ACT skills used for planning and advocacy rather than for changing her view.
Answer B: the marriage
“It’s Cathal. He’s lovely about it. But when he’s doing up my buttons I feel like I’ve stopped being his wife.”
Where the problem mostly sits: Ours.
A helpful focus: what the care is doing to intimacy, roles and desire, and whether some help could come from someone else so the marriage can be a marriage. Couples work may help.
Approaches that fit best: relational, object relations and systemic. See When Care Changes a Relationship and Disability, Sexuality and Care.
Answer C: an old rule
“I was brought up not to make a fuss. My mother never asked anyone for anything. Needing help feels shameful, even though I know it isn’t.”
Where the problem mostly sits: Mine.
A helpful focus: the rule itself, where it came from, what it protected, and whether it still fits her life now.
Approaches that fit best: person-centred, narrative, compassion-focused, or CBT work on rules and assumptions. See Core Beliefs, Rules and Assumptions.
Answer D: the loss
“It’s that I could do it a year ago. Every morning reminds me what’s changed, and what might change next.”
Where the problem mostly sits: Mine, alongside the body’s real changes.
A helpful focus: grief and uncertainty, not a belief to correct or a behaviour to change. Room for sadness and fear about the future.
Approaches that fit best: person-centred, ACT, and work on uncertainty. See Grieving the Life You Expected and Chronic Illness & Uncertainty.
In real life the answer is often “all of them”. Then the question becomes which part Róisín wants to work on first, and whether anything practical needs to change before deeper work makes sense. If the mornings are humiliating every day, exploring childhood rules first may feel like being asked to adjust to something that should change.
Asking before deciding
Illustrative dialogueYou said you hate having to ask for help getting dressed, and then we moved on quite quickly. Would it be all right to go back to it?
If you like. There’s not much to say. It’s just how it is now.
It might be how it is. I’m curious what the hardest part is. It could be lots of things: the help itself, who gives it, how it feels, what it means. I don’t want to guess.
Honestly? The agency. And then I feel guilty for complaining, because at least I get help.
So there are two things: what the agency is actually doing, and a voice telling you you’re not allowed to mind. Which would you like to look at first?
The agency. If that was sorted I think the guilt would be smaller.
The therapist doesn’t decide between the theories. Róisín’s answer does. The guilt is still noted and can be returned to later.
How you’d know it helped
Feedback- Róisín says the therapist understood what the problem actually was.
- Something concrete shifts if the problem was practical: a consistent assistant, more time in the mornings, a care review requested.
- She eats breakfast again, or returns to the book group, because mornings cost less.
- She can name feelings about needing help without apologising for them.
- She feels freer to say when a direction in therapy isn’t helping.
Signs it isn’t helping: she starts agreeing quickly and saying less, or she says therapy is “fine” while nothing outside it changes. Those are worth asking about directly.
When the therapist gets it wrong
RepairImagine a different therapist heard “I hate having to ask” and went straight to a CBT reading: “What’s the evidence that you’re a burden?” Róisín answered politely, did the thought record, and said less the following week. The burden thought was not the main problem. The agency was.
I want to go back to something. When you talked about needing help, I went straight to whether you’re a burden. I didn’t ask what was actually happening in your mornings. I think I treated it as a thinking problem too quickly.
It did feel a bit like I was being told it was in my head. The carers really are rushed.
That’s important, and I’m sorry I missed it. Can we start with what the mornings are really like, and what would need to change? If the guilt is still there afterwards, we can look at it then, if you want to.
What changes as a result: the thought record is set aside. The next sessions focus on what Róisín wants from her care and how to ask for it, using the access request template. The formulation is rewritten with the service as a central factor. An apology alone would not have been the whole repair. See Rupture and Repair.
Words you can use
For clientsMore scripts are in the Self-Advocacy Script Library.
Questions worth carrying, as a therapist
Therapist Reflection- Which reading did I reach for first, and was that about the client or about my training?
- Did I ask what the hardest part was before choosing a method?
- Did I treat an accurate prediction as a distortion?
- Did I make doing things alone the goal, when the client wanted control over how help is given?
- If the care arrangement is the problem, am I willing to work on it, or do I see it as outside therapy?
- Did validating injustice stop me noticing her grief, or the other way round?
- What would Róisín say I misunderstood?
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Conditions of worth come from Carl Rogers’ 1959 chapter “A theory of therapy, personality, and interpersonal relationships, as developed in the client-centered framework”, in S. Koch (ed.), Psychology: A Study of a Science, Vol. 3.
ACT’s acceptance, values and committed action are set out in Hayes, Strosahl & Wilson, Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2nd ed., Guilford, 2012).
Narrative therapy’s approach to the stories people live by, including externalising problems, comes from White & Epston, Narrative Means to Therapeutic Ends (Norton, 1990).
Compassion-focused therapy is introduced in Gilbert, P. (2009), “Introducing compassion-focused therapy”, Advances in Psychiatric Treatment, 15, 199–208.
The independent living view of independence as choice and control over assistance is discussed in Jenny Morris, Independent Lives? Community Care and Disabled People (Macmillan, 1993). Philosophical work on dependency as a normal part of human life includes Eva Feder Kittay, Love’s Labor: Essays on Women, Equality, and Dependency (Routledge, 1999).
The side-by-side comparison, the “what it can miss” notes and the use of Mine, Yours, Ours, System are this site’s synthesis for teaching. They are not a validated assessment method.
Róisín, Cathal and the dialogues are constructed for learning. They are not real people or real sessions.
We have not located research comparing how different therapy approaches formulate disabled clients’ difficulties with receiving personal care, or which approach helps most.